Nature in the raw
Sunday 07 June 1998
ON THE MORNING when that blue line appeared on my pregnancy test, I had already decided that I wanted a home birth. I was convinced, as I still am, of the benefits to both mother and baby of a low intervention, active delivery in a supportive atmosphere with peace and privacy afterwards.
As I read more about the subject I became even more convinced that hospitals were dangerous places for babies to be born in. As Sheila Kitzinger puts it in Home Birth and Other Alternatives to Hospital: "In hospital the moment that babies are born, they are... subjected to a range of practices which cause distress and interfere with their smooth adjustment to life." Kitzinger goes on to describe suctioning of mucus from the baby's mouth and nose, scouring of the stomach contents, irritating drops in the eyes, isolation and emotional deprivation. By contrast, only at home "can a woman be sure that her healthy baby remains with her and will never be taken away from her for any reason whatever, unless she wishes it." There was also that crucial first moment of "bonding": yours is the first face your baby sees, and by gazing at your face your baby, apparently exquisitely receptive, "bonds" to you. This would be easier to organise at home, and as Kitzinger had warned me, "To interfere with or destroy that intimacy is to risk interrupting a vital psychological process that may reduce a woman's confidence in herself as a mother and interfere with the flow of communication between herself and her baby."
I did, however, have doubts about whether at 39, with a smallish build, I would be able to give birth at home naturally. But I was led at every turn to believe that I could. My midwife was encouraging. Active birth classes taught you a position to overcome every problem. In the active birth books, interventions are almost ignored; so unnecessary are they supposed to be, that Caesareans, forceps and the like are mentioned only in small print at the back. Obstetrician Yehudi Gordon promises that "active birth is normal and attainable for the vast majority of women and babies". Sheila Kitzinger has no doubts: "when a birth is active only a very small percentage of births end up as emergencies."
No figures are offered to back these statements, but there seems to be a suspiciously large number of women in my acquaintance who fall into this "very small percentage". And I ended up one of them myself. After a reasonably long labour, despite any amount of yoga, massage, breathing, and climbing in and out of the birth pool, my baby began to pass meconium, so I was rushed into hospital, where he was pronounced thoroughly stuck, and delivered by emergency Caesarean. It was the exact antithesis of everything that I believed was desirable: indeed, it was all I had been warned to avoid. Instead of having my newborn in his first moments naked against my bare skin, soft lights and music, being welcomed gently into the world by myself and his father, there he was, being suctioned, tested, separated from me - as I lay paralysed on the slab, unable even to hold him, let alone protect him from the medical personnel sticking tubes and needles into him (and me) and fretting about this, that and the other measurement. Whose was the first human face his little eyes had gazed upon? Not his loving mother but a masked monster who stuck a tube down his gullet.
Janet Balaskas, in an excess of a kind of birth-eroticism, had promised me that "at last your child is born and lies, alive and vibrant, before your eyes... This is a time to be together undisturbed, to share in the wonderful glow and the sacred atmosphere which usually follows the birth... After a few moments you will probably have an irresistible urge to touch your baby's body... then there is that marvellous moment when you first look into each others' eyes. As this happens a flood of intense emotion is likely to overwhelm you... you can now relax and enjoy the wonder of the first hours of the child's life outside the womb... holding your child in your arms for the first time is one of life's most moving experiences... " The mother who has been conscious and active "is radiant and transfigured... she experiences the glow of health and well-being and an overwhelming joy." To which I can only reply: "Ha bloody ha."
Instead of that beautiful moment, it was a morphine-furred nightmare. For the first few days in hospital I was just fighting to prevent yet more interventions on myself or the baby - and to find edible food and get a little sleep. But pretty soon the disappointment was compounded by the most dreadful rage and guilt. Rage that the hospital had assaulted my baby in the way I had firmly believed was wrong, guilt at having allowed him to be subjected to all this harm, guilt at having deprived him of those early golden moments of bonding - and dreadful anxiety that I was failing to relate properly to him as a consequence.
When I got home, the inner torment continued. Every single day, I went over the events of the birth again and again in my mind, asking myself what else I could have done to make it different, and I scrutinised my feelings towards Bryn: was I bonded with him properly, and he with me? Did I love him as much as I ought to, and if not, was it because of what had gone wrong at the birth? Seven months on, I still cannot think about Bryn's birth and early days without feeling distress and bitter regret. Yet my birth experience was such a "normal" one. A vast number of women have interventions, and those numbers must include many who, like myself, had hoped, planned and trained for something quite different, and who feel various degrees of shock, disappointment, guilt and grief as a result of their dashed hopes.
Gill, who lives in Sussex, had a similar experience to mine. After many hours labouring at home, where she had planned a water birth, she was transferred to hospital and had an emergency Caesarean. "It is a myth you are sold, the myth of the perfect birth. I went along to these classes and we did about three yoga positions, then a mediation on the theme of 'Your body knows how to give birth'. Well for some women that just isn't true. I thought it would be easy-peasy. I got to the point of looking forward to it - it was going to be such fun, me and Adam with our candles and our music. Sad, isn't it?" Gill never found out what happened to the other women in that yoga class, but of the seven women in the NCT group she joined second time around, only two had a "natural" delivery: there were four sections, two of them emergencies. In my own active birth group of around six women, at least one other had an emergency Caesarean. In my NCT group (yes, I really overdosed) all but one of us had interventions such as strong drugs, vacuum cups, or Caesars.
Jo Bexley, who lives in North London, also had an emergency Caesarean after preparing for and hoping for a natural, active birth. And like me, she feels guilt, shame and loss at not having given birth to her son Frank the "right" way. "It's a huge ache. Even though I tell myself again and again that he might have died, it still doesn't make it OK. I feel I don't deserve him, that I did nothing to earn him. When I go to the gym, I hope people will notice my nursing bra, but I don't want them to see the scar, to know that's the way he came out. Ridiculous isn't it?"
The association of medical interventions with some kind of moral failing seeps into the way many of us feel about birth - especially before we have actually been through it ourselves. I am not proud now of the way I so comprehensively "bought into" all this. I cringe now when I remember how smug and superior I felt at my classes for having booked a home birth. (As Gill put it, "you get the extra pat on the head".) Before Bryn's birth, I actually believed that women who had Caesareans, pethideine or forceps were misguided or even guilty - of weakness, bad planning and lack of commitment to the babe. I knew better. This judgmental view is pervasive. Jo recalls: "A friend said to me after Frank was born, 'I didn't think of you as the Caesarean type', and that was really hurtful."
And the active/natural birth movement is on hand to help you feel more inadequate and guilty. Several people, on being told what had happened, immediately urged me to visit a cranial osteopath with my son as "the baby needs the moulding of the head through the birth canal". (I went along, incidentally, and the osteopath pronounced Bryn to be in pretty good shape - and so it has proved.)
Having a Caesarean is particularly disappointing, but even if you manage a vaginal delivery, the experience, however natural, is almost always agonising and can be profoundly shocking and traumatic, as Kate Figes points out it in her recent book Life after Birth. Rather than taking a keen interest in their new baby immediately it is born, Figes says, "in reality few mothers have the strength or the inclination for anything more than a cup of tea". It seems the "sacred moment" I had so set my heart on is enjoyed only by a minority - and very few indeed having their first baby.
For all that the classes promise about the value of being prepared and in control, perhaps all that knowledge can leave women feeling more disappointed and disempowered when the experience goes "wrong". Jo points out that having different ideas from the professionals lays women open to more disappointment than they are bargaining for: "While so much of the active birth information is important, it should be taken on by the professionals and not left to a battle in the delivery room, which of course the woman in labour is bound to lose. She is at a huge disadvantage, she is in pain and terrified, while the professionals see it five times a night." Jo, too, feels she was misled. "The classes you go to and many of the books say it's so natural, and yet globally women and babies die all the time though childbirth."
So how cruel, when our babies (and indeed perhaps our own lives) have been saved by timely intervention, to end up feeling disappointed. I certainly have no grounds to fear that Bryn has suffered irreparable harm through his traumatic introduction to the world because he is an entirely wonderful child. But the feelings of loss, regret and failure as a mother still haunt me, and I don't think a day goes by without me going over some aspect of the birth yet again, without comfort.
In the end, isn't it a bit absurd to turn the birth process into such a production, when it lasts just a couple of days at the most, and might so easily go out of your hands - and there is a lifetime of parenting to prepare for? As Janet, who attended active birth classes, only to end up with a forceps delivery and a terrifying amount of pain, comments: "There is so much stress on the birth that you just don't think about what comes next. But after the birth, there you are with your baby, and you think 'Now what do we do?'"
I remain to be convinced that extensive preparation makes all that much difference to one's eventual birth experience. I did feel glad I knew the basics about what contractions were, how long labour lasted, what first and second stage were, and that being upright was often more comfortable than lying down. But actually I knew most of that before I went to my first class, and could have picked it up in three free sessions at the local health centre.
'The Encyclopedia of Pregnancy and Birth' by Janet Balaskas and Yehudi Gordon (Little Brown); 'Pregnancy and Childbirth' by Sheila Kitzinger (Penguin); 'Home Birth and Other Alternatives to Hospital' by Sheila Kitzinger (Dorling Kindersley); 'Life After Birth' by Kate Figes (Viking)
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